Table 1

Longitudinal study of blunt spleen injury by Fabian et al

Authors	Study	Findings
Charash et al1	Case report of early nonoperative management of BSI	Nonoperative management reasonable with strict patient criteria
Schurr et al2	309 total patients 69% managed nonoperatively Initial CT to determine management	Contrast blush on CT highly predictive of failure of observation for BSI
Gavant et al3	263 patients with BSI 40% treated nonop 85% of nonop treatment successful	Vascular abnormalities in BSI, aka pseudoaneurysms, highly associated with failure of nonop management
Davis et al4	524 patients, 66% managed initially without operation CT imaging to evaluate for pseudoaneurysm or blush	Embolization is successful in salvaging blunt spleen injuries in the setting of contrast blush or pseudoaneurysm
Bee et al5	558 patients with BSI 77% initially observed Age and higher grade of injury associated with higher failure	More severe splenic injuries may be managed nonoperatively with ever-improving success rates
Santaniello et al6	84 patients with blunt aortic injuries, 33% with associated intra-abdominal organ injury	It is safe to anticoagulated low-grade spleen or liver injuries in the setting of aortic repair
Miller et al7	803 patients with blunt spleen, liver or both spleen and liver injuries Assessed for missed injury in the setting of nonoperative management	Incidence of missed injury is very low (though greater with blunt liver over blunt spleen injury)
Malhotra et al8	1288 patients with blunt spleen, blunt liver or both injured	Patients with injury to both liver and spleen have higher ISS, greater mortality and higher rates of nonoperative failure
Weinberg et al9	426 patients with nonoperative management of BSI were managed with serial imaging	Improved late detection and embolization of pseudoaneurysm, further improving success of nonoperative management
Savage et al10	637 patients with BSI managed nonoperatively with serial imaging to determine healing rates	Most injuries heal by 2 months but 10% worsen. Recommend ongoing follow-up to 3 months
Zarzaur et al11	4103 patients with BSI assessed for readmission or late mortality	Most late splenectomies occur within 8 days but 1.4% of patients readmitted with spleen-related complications
Zarzaur et al28	Survey of practice patterns for management of BSI among AAST members	Considerable variation exists in regard to management of BSI, especially with higher grade injuries
Zarzaur et al29	11 793 patients from the NTDB identified to determine factors related to urgent splenectomy	Specific patient factors related to need for urgent splenectomy. Important hospital factors include region, hospital type and trauma center status

AAST, American Association for the Surgery of Trauma; BSI, blunt splenic injury; ISS, Injury Severity Score; NTDB, National Trauma Data Bank.